选择性垂体甲状腺激素抵抗的新认识

选择性垂体甲状腺激素抵抗是甲状腺抵抗综合征中的一种少见类型,为一种常染色体显性遗传性疾病.主要由于甲状腺激素受体β亚基基因突变所致.它的临床特征为轻度甲状腺功能亢进,实验室检查提爪游离T3游离T4升高的同时伴有促甲状腺激素的不适当分泌.治疗可选用三碘甲状腺醋酸、右旋T4、溴隐亭等,目前尚无根治方法.     

Extent of resection affects prognosis for patients with glioblastoma in non-eloquent regions

Glioblastoma (GBM) is a malignant cerebral neoplasm carrying poor prognosis. The importance of extent of resection (EoR) in GBM patient outcomes has been argued in the literature. Previous studies included tumors in eloquent regions of the brain. This confounds the role of EoR by including patients with intrinsically worse outcomes but will be over-represented in the reduced EoR category. In a homogenous group of patients in whom GTR was considered achievable, we investigated the effect of increasing EoR on survival. A retrospective review of 51 patients was undertaken. Quantitative, volumetric analysis of pre-operative and post-operative magnetic resonance image was compared with corresponding clinical details. The primary outcome measured was post-operative overall survival. Median overall survival was 18.3 months for GTR patients compared to 11.6 months for non-GTR (p = 0.025). Median pre-operative contrast-enhancing tumor volume for GTR patients was 54.7 cm³ and 24.9 cm³ for non-GTR. Post-operative median residual tumor volume was 1.1 cm³ in the non-GTR cohort. In multivariate analyses, GTR (HR [95% CI] = 0.973 [0.954–0.994], p = 0.00559) and increasing EoR (HR [95% CI] = 0.964 [0.944–0.985], p = 0.000665) remained predictors of survival. Centile dichotomization of EoR revealed 74% (HR [95% CI] = 0.351 [0.128–0.958], p = 0.0409) as the lowest threshold conferring statistically significant survival benefit. Where technically feasible, both GTR and EoR remained as independent prognostic factors for survival. GTR remains the gold standard for surgical treatment of GBM in patients, 74% being the minimum EoR required to confer survival benefit.     

Cortical mechanisms underlying variability in intermittent theta-burst stimulation-induced plasticity: A TMS-EEG study

ObjectiveTo test the hypothesis that intermittent theta burst stimulation (iTBS) variability depends on the ability to engage specific neurons in the primary motor cortex (M1).MethodsIn a sham-controlled interventional study on 31 healthy volunteers, we used concomitant transcranial magnetic stimulation (TMS) and electroencephalography (EEG). We compared baseline motor evoked potentials (MEPs), M1 iTBS-evoked EEG oscillations, and resting-state EEG (rsEEG) between subjects who did and did not show MEP facilitation following iTBS. We also investigated whether baseline MEP and iTBS-evoked EEG oscillations could explain inter and intraindividual variability in iTBS aftereffects.ResultsThe facilitation group had smaller baseline MEPs than the no-facilitation group and showed more iTBS-evoked EEG oscillation synchronization in the alpha and beta frequency bands. Resting-state EEG power was similar between groups and iTBS had a similar non-significant effect on rsEEG in both groups. Baseline MEP amplitude and beta iTBS-evoked EEG oscillation power explained both inter and intraindividual variability in MEP modulation following iTBS.ConclusionsThe results show that variability in iTBS-associated plasticity depends on baseline corticospinal excitability and on the ability of iTBS to engage M1 beta oscillations.SignificanceThese observations can be used to optimize iTBS investigational and therapeutic applications.     

Beta‐2 Receptor Antagonists for Traumatic Brain Injury: A Systematic Review of Controlled Trials in Animal Models

A systematic review and meta‐analysis of controlled trials was undertaken to assess the effects of beta‐2 receptor antagonists in animal models of traumatic brain injury (TBI). Database and reference list searches were performed to identify eligible studies. Outcome data were extracted on functional status, as measured by the grip test or neurological severity score (NSS), and cerebral edema, as measured by brain water content (BWC). Data were pooled using the random‐effects model. Seventeen controlled trials involving 817 animals were identified. Overall methodological quality was poor. Results from the grip test suggest that the treatment group maintained grip for a longer period than the control group; pooled weighted mean difference (WMD) = 8.28 (95% CI 5.78–10.78). The treatment group was found to have a lower NSS (i.e., better neurological function); pooled WMD =?3.28 (95% CI ?4.72 to ?1.85). Analysis of the cerebral edema data showed that the treatment group had a lower BWC than the control; pooled WMD =?0.42 (95% CI ?0.59 to ?0.26). There was evidence of statistical heterogeneity between comparisons for all outcomes. Evidence for small study effects was found for the grip test and BWC outcomes. The evidence from animal models of TBI suggests that beta‐2 receptor antagonists can improve functional outcome and lessen cerebral edema. However, the poor methodological quality of the included studies and presence of small study effects may have influenced these findings.     

湘江衡阳段水体总α、β放射性水平调查与评价

目的 对湘江衡阳段水体中总放射性水平进行检测,并对数据进行放射卫生学评价。方法 利用²⁴¹Am和KCl作为总α、β放射性测量的标准物质,采用中等厚度相对测量法测量衡阳段湘江水中总放射性水平。结果 水样中总α放射性水平为0.0012~0.058 Bq/L,总β放射性水平为0.013~0.3742 Bq/L,经方差分析,各水样间差异无统计学意义(P > 0.05)。结论 水样中总α、总β放射性活度均低于国家标准限值,可知湘江衡阳段水体未受到人工放射性核素的污染。     

Étude d’une population d’enfants porteurs de paralysie cérébrale : description de caractéristiques cliniques potentiellement corrélées à la morbidité respiratoire

ObjectiveDescribe the history of respiratory morbidity in a population of 30 children with cerebral palsy and to link this development with different clinical signs that may have an impact on lung function. The prospects of such a study would identify some clinical criteria, risk markers for respiratory pathologies, easy to detect outside a hospital setting.MethodsData collection from folder items of each child: health record, nursing records, medical and paramedical folder, and gathering additional information by questionnaires to speech therapists and educators.ResultsIt appears that the more children with cerebral palsy are severely affected in their motor skills, the more they have substantial respiratory history. Children who belong to category 5 on the scale of Gross Motor Function Classification System (GMF-CS) present the following common characteristics: more episodes of inflammations and/or infections of the upper and lower airways than children having lower quotes GMF-CS, postural weakness of the trunk (100%), control deficits of breath and speech (100%), deficits in motor control and sensory integration of the buccal cavity, pharynx and larynx, characterized by impaired swallowing (100%), salivary leakage (100%), a suitable diet and risk of aspiration in 8 of 9 cases, an underweight in 7 of 9 cases. Children of categories GMF-CS below do not include all these features so significantly. However, some children rated 4 have some of these features added.ConclusionChildren with cerebral palsy do not seem all equal faced to respiratory events; the motor and nutritional characteristics identified in our work should be studied as part of a prospective cohort study in order to determine their relevance or not as a respiratory disease risk factor disabling on medium-term. The final aim would be to develop the preventive aspect of the respiratory care of children with cerebral palsy.     

Triad-conditioning Transcranial Magnetic Stimulation in Parkinson's Disease

BackgroundTranscranial magnetic stimulation (TMS) has been used to reveal excitability changes of the primary motor cortex (M1) in Parkinson's disease (PD). Abnormal rhythmic neural activities are considered to play pathophysiological roles in the motor symptoms of PD. The cortical responses to external rhythmic stimulation have not been studied in PD. We recently reported a new method of triad-conditioning TMS to detect the excitability changes after rhythmic conditioning stimuli, which induce facilitation by 40-Hz stimulation in healthy volunteers.ObjectiveWe applied a triad-conditioning TMS to PD patients to reveal the motor cortical response characteristics to rhythmic TMS.MethodsThe subjects included 13 PD patients and 14 healthy volunteers. Three conditioning stimuli over M1 at an intensity of 110% active motor threshold preceded the test TMS at various inter-stimulus intervals corresponding to 10–200 Hz.ResultsThe triad-conditioning TMS at 40 Hz induced no MEP enhancement in PD patients in either the On or Off state, in contrast to the facilitation observed in the normal subjects. Triad-conditioning TMS at 20–33 Hz in the beta frequency elicited significant MEP suppression in PD patients. The amount of suppression at 20 Hz positively correlated with the UPDRS III score.ConclusionWe observed abnormal M1 responses to rhythmic TMS in PD. The suppression induced by beta frequency stimulation and no facilitation by 40-Hz stimulation may be related to abnormal beta and gamma band activities within the cortical-basal ganglia network in PD patients. The motor cortical response to rhythmic TMS may be an additional method to detect physiological changes in humans.     

β?受体阻滞剂联合稳心颗粒治疗心血管神经症的疗效评价

目的评价β-受体阻滞剂联合稳心颗粒治疗心血管神经症的临床疗效。方法选取我院收治的80例心血管神经症患者为研究对象,按照随机平行分组法分为治疗组与对照组各40例,对照组给予美托洛尔口服30mg/次,2次/d;治疗组加用稳心颗粒(主要成分为党参、黄精、三七等)口服9g/次,3次/d。疗程为8周。结果治疗组与对照组临床愈显率分别为90.0%、65.0%,治疗组愈显率明显高于对照组(χ~2=21.520,P=0.018);治疗前2组SSS评分比较差异无统计学意义(P0.05),治疗4、8周时均较治疗前明显降低(P0.05),同期组间比较治疗组较对照组降低更明显,差异具有统计学意义(P0.05)。结论β-受体阻滞剂联合稳心颗粒治疗心血管神经症效果理想,值得推广应用。     

基于放疗中重复四维CT的食管癌大体肿瘤体积位移变化的比较研究

目的 基于重复四维CT (4DCT)模拟定位增强扫描探讨放疗中胸段食管癌原发肿瘤分次放疗内靶区位移变化。方法 29例胸段食管癌患者分别于放疗前及放疗10、20、30次时行4DCT模拟定位增强扫描,获得各时相原发肿瘤大体肿瘤体积(GTV)及内大体肿瘤体积(IGTV)。比较同次4DCT扫描所得胸上、中、下段食管癌GTV三维方向位移差异,各时段4DCT扫描所得同段食管癌GTV间同一方向位移差异及疗程中IGTV空间位置和体积变化。结果 胸中段患者初次及放疗20次时GTV位移在左右、前后、上下方向均不同(P=0.000~0.016),放疗10次时GTV位移上下与左右、前后方向均不同(P=0.000~0.006);胸下段患者初次及放疗10、20次时GTV位移上下与前后方向也不同(P=0.004~0.013);放疗疗程中不同治疗时段间GTV同一方向位移均相似(P=0.102~0.823)。疗程中IGTV空间位置变化不明显(P=0.689~0.999),而其体积在放疗20次时缩小最明显(P=0.012~0.029)。结论 放疗疗程中不同时段同一部位食管癌同一方向位移变化并不明显,尽管放疗20次时IGTV明显缩小但疗程中其空间位置变化不大。     

2013—2020年辽宁红沿河核电站周围地区的食品放射性水平及公众内照射剂量研究

目的 评价辽宁红沿河核电站运行后对周边地区食品放射性水平的影响。方法 通过对2013年至2020年核电站运行期间周边30 km范围内食品放射性水平的分析,对比核电站运行前后及对照点的放射性水平,评估核电站的运行对当地食品放射性水平的影响。结果 当地食品中未发现¹³¹I、¹³⁴Cs、⁶⁰Co、⁵⁸Co、¹¹⁰Ag^m等人工放射性核素,天然放射性核素²³⁸U、²²⁶Ra、²³²Th、⁴⁰K均在正常本底水平,平均值分别为（0.088±0.053）、（0.155±0.178）、（0.314±0.388）和（81.3±18.1） Bq/kg （鲜重）。食品样品中人工放射性¹³⁷Cs活度浓度平均值为（0.013±0.010） Bq/kg （鲜重）。与对照点及运行前水平比较,放射性核素水平未见增加。结论 红沿河核电站的运行未对周边食品放射性水平带来影响。